Provider Demographics
NPI:1174947162
Name:TMS SURGICAL PLLC
Entity type:Organization
Organization Name:TMS SURGICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:MORELLO
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:754-264-2407
Mailing Address - Street 1:4245 BANYAN TRAILS DR
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-5105
Mailing Address - Country:US
Mailing Address - Phone:754-264-2407
Mailing Address - Fax:
Practice Address - Street 1:9960 CENTRAL PARK BLVD N STE 235
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-1760
Practice Address - Country:US
Practice Address - Phone:561-483-8840
Practice Address - Fax:561-483-3342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-11
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9107748363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty